Τρίτη, 30 Αυγούστου 2016

Continuous ambulatory adductor canal catheters for patients undergoing knee arthroplasty surgery

To determine after knee arthroplasty surgery the feasibility of discharging patients home on postoperative day 1 with continuous adductor canal blocks.

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Variations in the distance between the cricoid cartilage and targets of stellate ganglion block in neutral and extended supine positions: an ultrasonographic evaluation

Abstract

Purpose

Anatomic variations complicate surface landmark-guided needle placement, thereby increasing nerve blockade failure rate. However, little is understood about how anatomic distances change under different clinical conditions. As the cricoid cartilage is an easy and accurate landmark, we investigated changes in distance between the sixth or seventh cervical transverse processes (C6TP or C7TP) and the cricoid cartilage in neutral and extended supine positions.

Methods

Forty-two patients (16 men, 26 women) were included in this study. Distances between the cricoid cartilage and C6TP/C7TP were measured using ultrasonography with the patient in neutral and extended supine positions.

Results

C6TP and C7TP were caudally located at 6.0 ± 8.1 and 15.1 ± 7.2 mm, respectively, from the cricoid cartilage in the neutral supine position, and at 15.2 ± 8.0 and 25.3 ± 8.0 mm, respectively, in the extended supine position. In the extended supine position, the cricoid cartilage was more cephalad than C6TP and C7TP in all patients. The distance from the cricoid cartilage to C6TP was 12.1 ± 7.6 mm in men and 17.2 ± 7.7 mm in women.

Conclusion

C6TP and C7TP are located approximately 15 and 25 mm, respectively, caudal to the cricoid cartilage in the extended supine position. Our results highlight the fact that there can be significant anatomic variation between the extended and neutral supine positions used in stellate ganglion block, which should be kept in mind when devising easily identifiable and palpable surface landmarks.



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Patient Satisfaction and Prognosis for Functional Improvement and Deterioration, Institutionalization, and Death among Medicare Beneficiaries Over Two Years

Publication date: Available online 30 August 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Hillary R. Bogner, Heather F. de Vries McClintock, Jibby E. Kurichi, Pui L. Kwong, Dawei Xie, Sean Hennessy, Joel E. Streim, Margaret G. Stineman
ObjectiveTo examine how patient satisfaction with care coordination and quality and access to medical care influence functional improvement or deterioration (activity limitation stage transitions), institutionalization, or death among older adults.DesignA national representative sample with two year follow-up.SettingMedicare Current Beneficiary Survey (MCBS) from calendar years 2001-2008.ParticipantsOur study sample included 23,470 community-dwelling adults aged 65 years and older followed for two years.InterventionsNot applicable.Main Outcome Measure(s)A multinomial logistic regression model taking into account the complex survey design was used to examine the association between patient satisfaction with care coordination and quality and patient satisfaction with access to medical care and activity of daily living (ADL) stage transitions, institutionalization, or death after two years, adjusting for baseline socioeconomics and health-related characteristics.ResultsOut of 23,470 Medicare beneficiaries, 14,979 (63.8% weighted) remained stable in ADL stage, 2,508 (10.7% weighted) improved, 3,210 (13.3% weighted) deteriorated, 582 (2.5% weighted) were institutionalized, and 2,281 (9.7% weighted) died. Beneficiaries who were in the top quartile of satisfaction with care coordination and quality were less likely to be institutionalized (adjusted relative risk ratio (RRR) = 0.68, 95% confidence interval (CI): 0.54-0.86). Beneficiaries who were in the top quartile of satisfaction with access to medical care were less likely to functionally deteriorate (adjusted RRR = 0.87, 95% CI: 0.79-0.97), be institutionalized (adjusted RRR = 0.72, 95% CI: 0.56-0.92), or die (adjusted RRR = 0.86, 95% CI: 0.75-0.98).ConclusionsKnowledge of patient satisfaction with medical care and risk of functional deterioration may be helpful for monitoring and addressing disability-related healthcare disparities and the impact of ongoing policy changes among Medicare beneficiaries.



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High rate of hepatitis B viral breakthrough in elderly non-Hodgkin lymphomas patients treated with Rituximab based chemotherapy

Rituximab-containing chemotherapies are offered to elderlies for treatment of non-Hodgkin lymphomas (NHL). From 0.7 to 27% of patients with "resolved" HBV infection develop HBV reactivation and related hepatitis during Rituximab-containing chemotherapies. Currently, several antiviral drugs are available for the prophylaxis of patients at risk for HBV reactivation, which include lamivudine, tenofovir, entecavir, and adefovir. Viral breakthrough may occur during therapy, which is defined as an abrupt increase in serum HBV DNA levels after a period of persistent suppression.

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The multidisciplinary management of gastro-oesophageal junction tumours

The management of GOJ cancers remains controversial and may vary between countries. Evidence-based attitudes and guidelines are not easy to elaborate since most of the trials and studies reported mixed cases of oesophageal (both adenocarcinoma and squamous cell tumours), GOJ and gastric cancers. The aim of this expert discussion and position paper is to elaborate practical recommendations that integrate evidence-reported literature and experience-based attitude covering all clinical aspects of GOJ cancer across different specialities and countries in Europe.

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High rate of hepatitis B viral breakthrough in elderly non-Hodgkin lymphomas patients treated with Rituximab based chemotherapy

Rituximab-containing chemotherapies are offered to elderlies for treatment of non-Hodgkin lymphomas (NHL). From 0.7 to 27% of patients with "resolved" HBV infection develop HBV reactivation and related hepatitis during Rituximab-containing chemotherapies. Currently, several antiviral drugs are available for the prophylaxis of patients at risk for HBV reactivation, which include lamivudine, tenofovir, entecavir, and adefovir. Viral breakthrough may occur during therapy, which is defined as an abrupt increase in serum HBV DNA levels after a period of persistent suppression.

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The multidisciplinary management of gastro-oesophageal junction tumours

The management of GOJ cancers remains controversial and may vary between countries. Evidence-based attitudes and guidelines are not easy to elaborate since most of the trials and studies reported mixed cases of oesophageal (both adenocarcinoma and squamous cell tumours), GOJ and gastric cancers. The aim of this expert discussion and position paper is to elaborate practical recommendations that integrate evidence-reported literature and experience-based attitude covering all clinical aspects of GOJ cancer across different specialities and countries in Europe.

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Chromatin: Xist as a recruitment tool

Nature Reviews Genetics. doi:10.1038/nrg.2016.116

Author: Denise Waldron



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Specification and epigenetic programming of the human germ line

Nature Reviews Genetics. doi:10.1038/nrg.2016.88

Authors: Walfred W. C. Tang, Toshihiro Kobayashi, Naoko Irie, Sabine Dietmann & M. Azim Surani



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Evolution to the rescue: using comparative genomics to understand long non-coding RNAs

Nature Reviews Genetics. doi:10.1038/nrg.2016.85

Author: Igor Ulitsky



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Are EMTs resilient enough?

Improving resiliency through regular exercise and smart nutrition is essential to helping EMS providers cope with traumatic stress.

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Are EMTs resilient enough?

Friese_FC.jpg

By Bryan Fass

While even normal people outside of public safety experience job-related stress as a fact of life, it seems like ours is much worse. Those of us who've in the business for a while can remember a time where the topic of stress and stress management were never discussed. Thankfully, EMS has taken a great leap forward bringing to light the depth and severity of our mental health.

Stress can be good and bad. Exercise induced stress is good. It forces our body to grow, heal and improve. The stress you experience prior to a protocol test increases your mental acuity.

The trouble starts when the stress response is constant and your body has no time to reset and rebalance. As call volumes have increased, so have resiliency issues for EMS providers.

As a paramedic and as a strength coach I have often wondered what has changed.

  • Why has the rate of suicide and mental health issues increased"
  • Is it the call volume, is it the type of calls or have we changed"

Next read these questions. I want to spark a conversation. Share your answers with me in the comments or send me an email. Together, we can hopefully steer the profession in a healthier direction.

  • Is our inability to handle stress because we have lost the ability to separate from the job"
  • Have we lost the ability for physical outlets to help manage the stress"
  • Are we poisoning ourselves with a toxic combination of overtime, poor eating habits and reliance on stimulants"

I can recall as a green medic running my first pediatric traumatic arrest. Sure, I had read about it, studied it and even did hours of training in the NICU. Yet having to manage the scene, intubate the child while en route, start compressions, start an IO and then carry a child I knew was deceased into the emergency department was very foreign to me.

I recall standing there as the trauma team worked the child, being expected to calmly and accurately give a report and then go write my patient care report. I had no training for that and no way to manage those emotions. Yes, that call weighed on me the rest of the shift, but I pushed on.

Exercise to increase resiliency
However as soon as my shift ended I drove right to the gym and hammered myself with an epic workout; that was and is my outlet, my relief valve. Studies show that exercise, any exercise, calms the mind and releases endorphins that help promote wellness [1, 2, 3].

Exercise is by far the best medicine for building resiliency. The data is clear. Any exercise is beneficial with cardiovascular exercise shown to be slightly superior. As I have said in multiple EMS1 columns move well and move often but just move.

Another issue is our addiction to technology. When I was a street medic you were connected only if you had a Nextel phone (the walkie talkie phone). Now there is an app for constant communication. I often wonder if after a series of difficult calls when an EMT should disconnect from the stressor and find an outlet if the news feeds, photos, texts and instant messages that flood in slowly elevate the long-term stress response.

Disconnect from the world and get after it. The stronger you are and the more fit you are, the less pain you experience. Exercise will boost your resiliency and help to improve your sleep and nutrition.

Let's face it: the EMS diet is not so good. Not only do you have to contend with the call volume and missed meals; bringing your food with you will fix that. We also have to deal with stress eating and fatigue eating. There is a reason that you crave the foods that are bad, and understanding why is the first step.

Eat better to improve resiliency
The overconsumption of sugars and caffeine plus a diet devoid of beneficial nutrition when tied into the over stimulation of the stress response throws the serotonin, cortisol, adrenalin response and more importantly the recovery process so far out of whack that we are essentially poisoning ourselves and making ourselves vulnerable to the cumulative dangers of bad stress [4]. Soldiers that died by suicide were 62 percent more likely to have extremely low levels of DHA (the good fat in fish and chia/flax that helps your brain) then soldiers that did not attempt suicide [5].

On top of that, too many first responders are self-medicating with alcohol and drugs. This destroys the allostatic balance leading responders into a deep, dark hole.

A key to boosting resiliency in EMS requires that EMT's have a physical outlet for their stress. Tie in good nutrition that heals, and you can boost your resiliency and wellness at the same time.

References

  1. Perspectives in Rehabilitation. Exercise therapy improves both mental and physical health in patients with major depression. DOI: 10.3109/09638288.2014.972579. Knapen, Davy Vancampfort, Yves Moriën and Yannick Marchal. Pages 1490-1495
  2. Exercise and well-being: a review of mental and physical health benefits associated with physical activity Penedo, Frank J; Dahn, Jason R
  3. http://ift.tt/2bzVlli
  4. http://ift.tt/1GsrWTc
  5. Lewis, Michael et.al. "Suicide of active duty us military and omegs-3 fatty acid status. The Journal of Clinical Psychiatry 72.12 (2011): 1585.


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My children don’t know their father before PTSD

soldier_with_ptsd.jpg

By Lea Farrow, Uniform Stories Contributor

It has been almost five years since my husband was diagnosed with PTSD. In a lot of ways, it feels like a lifetime. And for our children, it has literally been their lifetime.

I knew my husband for nine years before his official diagnosis. However, I really only knew my husband for five years before the signs of the disorder started to show.

My husband has been a paramedic for 15 years. His PTSD didn't arrive overnight. It was an insidious process after years of answering extremely traumatic calls, and receiving very little support or education through the service about ongoing stress management.

Many of the jobs that led to my husband's PTSD were pediatric calls. The job that triggered his major collapse was a horrific pediatric death. At the time, we had two small children of our own, our daughter was almost 3 and our son was not yet 1.

The day my husband came home from work a broken man, he fell to pieces in the kitchen. It wasn't that I hadn't seen him cry before, but we could have both drowned in his tears that night.

Although I tried my best, I couldn't protect our children from every episode that ripped through our house. Sometimes the pain would burst out of my husband so suddenly and ferociously, that all I could do was huddle my kids until the storm passed. Our daughter would ask, "Mommy, what's happening" Daddy is really scaring me…"

I had to accept the reality that my children were not safe alone with their father. One day I was torn away from work by a desperate phone call, and rushed home to a find a shattered man, only barely holding on. I often ask, do our children remember that day" Do they remember the raw anguish coursing wildly out of their father, who scarcely had enough strength left to direct it away from us" I sure do.

We found new ways to manage as a couple and as a family. I helped my husband begin to earn back the trust from his children and he found help for his PTSD (when he was ready to accept it). We have come a long way in the years since, but PTSD is still very much with us. It'll be with us always. And our children sadly bear witness to some of its worst moments. They don't know a life without PTSD overshadowing it.



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EMS needs planning, preparation to mitigate the effects of terrorist attacks

san_bernadino_FC.jpg

In June 2016 the National Academy of Medicine released a discussion paper that looked at the challenges of an EMS response to a major terror attack. In the paper, "Health and Medical Response to Active Shooter and Bombing Events," members of the National Academies of Sciences, Engineering, and Medicine's Forum on Medical and Public Health Preparedness for Catastrophic Disasters described potential best practices on how to respond effectively to sudden, dramatic mass casualty events, based on data gleaned from recent attacks in Europe and the U.S.

Most of us are still relatively complacent about what we would do in case of a Boston or Aurora style attack in our community. Indeed, chances are very remote that such attacks will occur.

However, in such cases, the actions of dispatch centers and field personnel may play a critical role in the victims' chances of survival. It is common sense that EMS, fire and law enforcement personnel should jointly prepare and train for a variety of sudden mass casualty events.

Work together, train together
As the National Academy of Medicine discussion paper implies, a variety of political, fiscal and bureaucratic barriers exist to hinder the development of such plans. Both government and private sector agencies charged with public safety and public health must put aside territorial differences and work together to determine who will respond, how teams will operate and where patients should be transported, all in a very short operational period.

Bleeding control is a major priority when managing large numbers of injured patients after an attack. In many situations, direct pressure bandages and tourniquets can rapidly control bleeding, and free up field providers to provide care to other injured victims.

Unfortunately, ambulances and engine companies often do not carry enough trauma supplies to handle more than a few victims simultaneously. Disaster caches or trailers can be helpful, but only if they can be rapidly moved to the scene within minutes of the initial dispatch.

Rural and remote areas
Rural regions face especially difficult challenges in a mass casualty response. Underfunded agencies and scattered resources can hinder an adequate response.

One simple solution is to have policies in place that initiate mutual aid from neighboring agencies automatically at the initial response, rather than waiting precious minutes for the first responding units to arrive. This would include air medical services, volunteer organizations and even agencies that are a fair distance away from the incident, but would be expected to respond in large scale events.

The delay in sending an appropriate response level can result in lives lost. Dispatch protocols should be developed that result in an adequate number of units and personnel being sent to initial reports of a major event, similar to fire service alarm assignments.

This can reduce the human judgment factor during dispatch and improve the chances of getting off on the right foot early in the incident. If it turns out that the incident is smaller than reported, no harm is created in downgrading the response.

Cooperation with receiving facilities
Emergency departments and hospitals will not be immune to the effects of a large scale event. Not only do such facilities have to be able to rapidly scale up their internal disaster response, they must also work in cooperation with each other to spread the multitude of patients around the region.

While field operations may perform the initial sorting and destination decisions, resources such as staff, blood products and equipment may be rapidly depleted, necessitating a rapid region-wide response by other facilities and organizations. Again, interagency agreements, policies and procedures should be in place to facilitate complex decision making processes.

No one wants to think about a major violent event happening in their community. As EMS providers, we have to prepare for the worst, and hope for the best. As the National Academy of Medicine paper points out, continuous planning and preparation will be the major tools used by field providers and agencies alike in mitigating the effects of a terror attack.

Health and Medical Response to Active Shooter and Bombing Events



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Are EMTs resilient enough?

By Bryan Fass

While even normal people outside of public safety experience job-related stress as a fact of life, it seems like ours is much worse. Those of us who've in the business for a while can remember a time where the topic of stress and stress management were never discussed. Thankfully, EMS has taken a great leap forward bringing to light the depth and severity of our mental health.

Stress can be good and bad. Exercise induced stress is good. It forces our body to grow, heal and improve. The stress you experience prior to a protocol test increases your mental acuity.

The trouble starts when the stress response is constant and your body has no time to reset and rebalance. As call volumes have increased, so have resiliency issues for EMS providers.   

As a paramedic and as a strength coach I have often wondered what has changed.

  • Why has the rate of suicide and mental health issues increased?
  • Is it the call volume, is it the type of calls or have we changed?

Next read these questions. I want to spark a conversation. Share your answers with me in the comments or send me an email. Together, we can hopefully steer the profession in a healthier direction.

  • Is our inability to handle stress because we have lost the ability to separate from the job?
  • Have we lost the ability for physical outlets to help manage the stress?
  • Are we poisoning ourselves with a toxic combination of overtime, poor eating habits and reliance on stimulants?

I can recall as a green medic running my first pediatric traumatic arrest. Sure, I had read about it, studied it and even did hours of training in the NICU. Yet having to manage the scene, intubate the child while en route, start compressions, start an IO and then carry a child I knew was deceased into the emergency department was very foreign to me.

I recall standing there as the trauma team worked the child, being expected to calmly and accurately give a report and then go write my patient care report. I had no training for that and no way to manage those emotions. Yes, that call weighed on me the rest of the shift, but I pushed on.

Exercise to increase resiliency
However as soon as my shift ended I drove right to the gym and hammered myself with an epic workout; that was and is my outlet, my relief valve. Studies show that exercise, any exercise, calms the mind and releases endorphins that help promote wellness [1, 2, 3].

Exercise is by far the best medicine for building resiliency. The data is clear. Any exercise is beneficial with cardiovascular exercise shown to be slightly superior. As I have said in multiple EMS1 columns move well and move often but just move. 

Another issue is our addiction to technology. When I was a street medic you were connected only if you had a Nextel phone (the walkie talkie phone). Now there is an app for constant communication. I often wonder if after a series of difficult calls when an EMT should disconnect from the stressor and find an outlet if the news feeds, photos, texts and instant messages that flood in slowly elevate the long-term stress response. 

Disconnect from the world and get after it. The stronger you are and the more fit you are, the less pain you experience. Exercise will boost your resiliency and help to improve your sleep and nutrition.

Let's face it the EMS diet is not so good. Not only do you have to contend with the call volume and missed meals; bringing your food with you will fix that. We have to deal with stress eating and fatigue eating. There is a reason that you crave the foods that are bad and understanding is the first step.

Eat better to improve resiliency
The overconsumption of sugars and caffeine plus a diet devoid of beneficial nutrition when tied into the over stimulation of the stress response throws the serotonin, cortisol, adrenalin response and more importantly recovery process so far out of whack that we are essentially poisoning ourselves and making ourselves vulnerable to the cumulative dangers of bad stress [4]. Soldiers that died by suicide were 62 percent more likely to have extremely low levels of DHA (the good fat in fish and chia/flax that helps your brain) then soldiers that did not attempt [5].

On top of that too many first responders are self-medicating with alcohol and drugs. This destroys the allostatic balance leading responders into a deep, dark hole.  

A key to boosting resiliency in EMS requires that EMT's have a physical outlet for their stress. Tie in good nutrition that heals, and you can boost your resiliency and wellness at the same time.

References

  1. Perspectives in Rehabilitation. Exercise therapy improves both mental and physical health in patients with major depression. DOI: 10.3109/09638288.2014.972579. Knapen, Davy Vancampfort, Yves Moriën and Yannick Marchal. Pages 1490-1495
  2. Exercise and well-being: a review of mental and physical health benefits associated with physical activity Penedo, Frank J; Dahn, Jason R
  3. http://ift.tt/2bzVlli
  4. http://ift.tt/1GsrWTc
  5. Lewis, Michael et.al. "Suicide of active duty us military and omegs-3 fatty acid status. The Journal of Clinical Psychiatry 72.12 (2011): 1585.


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Evaluation of the Carbapenem Inactivation Method for Detection of Carbapenemase-Producing Gram-Negative Bacteria in Comparison with the RAPIDEC CARBA NP

Microbial Drug Resistance , Vol. 0, No. 0.


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Purification of a Novel Bacteriocin-Like Inhibitory Substance produced by Enterococcus faecium ICIS 8 and Characterization of Its Mode of Action

Microbial Drug Resistance , Vol. 0, No. 0.


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Emergence of Multidrug-Resistant New Delhi Metallo-β-Lactamase-1-Producing Klebsiella pneumoniae in Egypt

Microbial Drug Resistance , Vol. 0, No. 0.


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EMS needs planning, preparation to mitigate the effects of terrorist attacks

A recent National Academy of Medicine discussion paper describes best practices for EMS and hospital responses to active shooter, bombing and terror attacks.

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Reference genomes of two indica rice varieties [Genetics]

Asian cultivated rice consists of two subspecies: Oryza sativa subsp. indica and O. sativa subsp. japonica. Despite the fact that indica rice accounts for over 70% of total rice production worldwide and is genetically much more diverse, a high-quality reference genome for indica rice has yet to be published. We...

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Genome-wide quantification of rare mutations [Genetics]

We present the bottleneck sequencing system (BotSeqS), a next-generation sequencing method that simultaneously quantifies rare somatic point mutations across the mitochondrial and nuclear genomes. BotSeqS combines molecular barcoding with a simple dilution step immediately before library amplification. We use BotSeqS to show age- and tissue-dependent accumulations of rare mutations and...

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Assessing the Accuracy of Reporting of Maternal Red Blood Cell Transfusion at Birth Reported in Routinely Collected Hospital Data

Abstract

Introduction Hospital administrative data collections have been used to describe transfusion practice, particularly in relation to the maternity population. Knowledge of the accuracy of this data is important in order to interpret the results of such studies. The aim of this study was to compare the accuracy of reporting of red cell transfusion around childbirth within hospital data with data submitted by hospital blood banks. Methods Linked hospital and birth data from New South Wales, Australia, between June 2006 and December 2010 were used to identify blood transfusions occurring at delivery. This reporting was compared with the gold standard of blood pack level information submitted by hospital blood banks, and sensitivity, specificity, and positive and negative predictive values calculated. Reporting related to quantity and timing of transfusion were also considered. Results Data were available for 235,796 births, with blood bank data identifying that 2.0 % of received a blood transfusion. Overall the sensitivity of hospital data for identifying transfusion was 84.8 % (95 % CI 83.7 %, 85.8 %) with specificity 99.9 % (99.9 %, 99.9 %). Sensitivity was better for births involving a postpartum haemorrhage [Sn 90.9 % (89.9 %, 91.9 %)], and poorer for births in regional hospitals [Sn 78.8 % (76.0 %, 81.5 %)]. Almost all (96 %) transfusions of 10 or more units were identified in hospital data, and there was no difference in reporting depending on whether the transfusion was on the baby's date of birth or not. Discussion The reliability of hospital reporting of transfusion in maternity patients is high, however with some underreporting of cases.



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Erratum to: Fragmentation of Care in Ectopic Pregnancy



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Reducing Iron Deficiency in 18–36-months-old US Children: Is the Solution Less Calcium?

Abstract

Objectives National surveys consistently identify iron deficiency (ID) in US children between 1 and 3 years of age, when the brain is rapidly developing and vulnerable to the effects of ID. However, controversy remains as to how best to recognize and prevent ID in young children, in part because of the multiple potential etiologies. The objective of this project was to assess ID in children and identify potential individual dietary predictors of status. Methods We examined three biomarkers of ID [soluble transferrin receptor (sTfR) and serum ferritin (SF), and body iron (calculated from sTfR and SF)] against parent-provided dietary calcium and iron intake for eight-three 18–36 month old children from middle class families. Results Using literature-based cutoffs, fourteen children (16.9 %) had at least one indicator of ID: low SF(<10 μg/l, 7.2 %), negative body iron (<0 mg/kg, 7.2 %) or elevated sTfR (>8.4 μg/ml, 13.2 %). All children consumed more than the Dietary Reference Intake (DRI) Estimated Average Requirement of 3 mg/d iron. The mean iron intake of children identified with ID approximated the Recommended Dietary Allowance of 7 mg/d. Most children (81 %) consumed above the DRI Adequate Intake of 500 mg/d of calcium. Calcium intakes were generally high and predicted lower body iron (p = 0.0005), lower SF (p = 0.0086) and higher sTfR (p = 0.0176). Conclusions for Practice We found rates of ID similar to US national averages. Dietary calcium intake predicted lower iron status more than deficits in iron intake. Teaching parents to balance calcium and iron intake in toddlers could be a strategy to prevent ID.



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Social Capital and Well-Being: Structural Analyses of Latina Mothers by Nativity

Abstract

Objective This study examined the direct and mediating effects of maternal social capital on health and well-being for native- and foreign-born Latina mothers and their children. Methods Data were drawn from the baseline and nine-year follow up waves of the Fragile Families and Child Well-being Study. The study included a sample of 874 Latina mothers. Mplus7 was used to perform structural equation modeling to determine whether exogenous indicators (age, education, and economic well-being) predicted social capital, whether social capital predicted mother and child well-being, and whether mediating effects helped explain each relationship. Results For native-born Latinas (n = 540), social capital did not predict maternal or child well-being. However, social capital significantly mediated the effects of age, education, and economic well-being on maternal well-being. For foreign-born Latinas (n = 334), social capital was a significant predictor of maternal well-being. Social capital also mediated the effects of age, education, and economic well-being on maternal, but not child well-being. Younger and foreign-born Latinas who report higher educational attainment and economic well-being have greater social capital, and thus better self-reported health. Conclusion Findings suggest that social capital is particularly relevant to the health of foreign-born Latinas. For all Latina mothers, social capital may serve as a protective mitigating factor to better health. Health service providers should evaluate the potential to integrate programs that promote social capital accumulation for Latinas. Further research should examine factors to improve the health of Latinas' children.



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Preferred Child Body Size and Parental Underestimation of Child Weight in Mexican-American Families

Abstract

Objective To determine whether parents who prefer a heavier child would underestimate their child's weight more than those who prefer a leaner child. Methods Participants were Mexican-American families (312 mothers, 173 fathers, and 312 children ages 8–10) who were interviewed and had height and weight measurements. Parents reported their preferred child body size and their perceptions of their child's weight. Parents' underestimation of their child's weight was calculated as the standardized difference between parent's perception of their child's weight and the child's body mass index (BMI) z-score. Demographic factors and parental BMI were also assessed. Results Although 50 % of children were overweight or obese, only 11 % of mothers and 10 % of fathers perceived their children as being somewhat or very overweight. Multiple regressions controlling for covariates (parental BMI and child age) showed that parents who preferred a heavier child body size underestimated their children's weight more, compared to those who preferred a leaner child (β for mothers = .13, p < .03; β for fathers = .17, p < .03). Conclusions for Practice Parents who preferred a heavier child body size underestimated their child's weight to a greater degree than parents who preferred a leaner child. Attempts by pediatricians to correct parents' misperceptions about child weight may damage rapport and ultimately fail if the misperception is actually a reflection of parents' preferences, which may not be readily amenable to change. Future research should address optimal methods of communication about child overweight which take into account parent preferences.



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Factors Contributing to Background Television Exposure in Low-Income Mexican–American Preschoolers

Abstract

Objective Background television (TV) exposure is harmful to young children, yet few studies have focused on predictors of exposure. This study's objectives were to elucidate demographic, environmental, and behavioral correlates of background TV exposure in low-income Mexican–American preschoolers and to explore caregiver beliefs about the impact of such exposure. Methods A convenience sample of low-income Mexican–American female primary caregivers of preschoolers (3–5 years old, n = 309), recruited in safety-net clinics, were surveyed by phone. Caregivers reported the frequency of their child's exposure to background TV and responded to questions on the home media environment, TV use, and whether they had thought about background TV exposure and its impact on their child. Results Background TV exposure was common; 43 % reported that their child was often, very often, or always exposed to background TV. More hours of TV viewing by the caregiver and greater frequency of TV viewing during meals were associated with an increased frequency of exposure to background TV. Only 49 % of participants had ever thought about the impact of background TV. Believing that background TV is not harmful was associated with higher levels of background TV exposure. Conclusions Findings suggest that background TV exposure is frequent and caregiver awareness of its potential impact is low in low-income Mexican–American families. Beliefs that background TV is not harmful may predict risk of exposure. Potential targets for interventions focused on reducing background TV exposure in this population include increasing caregiver awareness of the potential negative impact of such TV exposure.



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Who are the Women Who Work in Their Last Month of Pregnancy? Social and Occupational Characteristics and Birth Outcomes of Women Working Until the Last Month of Pregnancy in France

Abstract

Introduction The prenatal leave law in France protects women during pregnancy and their employment. We aimed to estimate the proportion of women who worked late in their pregnancy, to analyze the occupational, social and medical factors associated with late prenatal leave and to compare the pregnancy outcome of these women and those who left earlier in the pregnancy. Methods The sample was extracted from the 2010 French National Perinatal Survey. All women who delivered within a 1-week period were interviewed before discharge from the maternity unit. Women with a singleton live birth at or after 37 weeks' gestation and who were working during pregnancy (n = 8463) were included. Data were collected on employment, date of leave, and sociodemographic and medical characteristics. Results Overall, 328 women (3.9 %) took a late prenatal leave (at or after 37 weeks' gestation). Women who left late were older than 30 years old, with a high educational level and were living in an urban area. Being self-employed and having a managerial or upper-intellectual occupation was highly associated with late leave, before and after controlling for relevant variables. Perinatal and delivery outcomes were similar for women who took a late leave and those who left before 37 weeks' gestation. Discussion Occupational characteristics are the main determinants of late prenatal leave. Women working in the last month of pregnancy had a favorable social and occupational situation and did not did not experience an adverse pregnancy or birth outcome. Other studies are needed to understand the reasons for late leave and evaluate the post-partum fatigue and health of these women.



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Reliability and Validity of a Chinese-Translated Version of a Pregnancy Physical Activity Questionnaire

Abstract

Objectives The objectives of the present study were to translate the English version of the Pregnancy Physical Activity Questionnaire into Chinese (PPAQ-C) and to determine its reliability and validity for use by pregnant Chinese women. Methods The study included 224 pregnant women during their first, second, or third trimesters of pregnancy who completed the PPAQ-C on their first visit and wore a uniaxial accelerometer (Lifecorder; Suzuken Co. Ltd) for 7 days. One week after the first visit, we collected the data from the uniaxial accelerometer records, and the women were asked to complete the PPAQ-C again. Results We used intraclass correlation coefficients to determine the reliability of the PPAQ-C. The intraclass correlation coefficients were 0.77 for total activity (light and above), 0.76 for sedentary activity, 0.75 for light activity, 0.59 for moderate activity, and 0.28 for vigorous activity. The intraclass correlation coefficients were 0.74 for "household and caregiving", 0.75 for "occupational" activities, and 0.34 for "sports/exercise". Validity between the PPAQ-C and accelerometer data was determined by Spearman correlation coefficients. Although there were no significant correlations for moderate activity (r = 0.19, P > 0.05) or vigorous activity (r = 0.15, P > 0.05), there were significant correlations for total activity [light and above; r = 0.35, P < 0.01)] and for light activity (r = 0.33, P < 0.01). Conclusions for Practice The PPAQ-C is reliable and moderately accurate for measuring physical activity in pregnant Chinese women.



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Racial/Ethnic Disparities in the Association Between Preeclampsia Risk Factors and Preeclampsia Among Women Residing in Hawaii

Abstract

Objective To assess differences in the rates of preeclampsia among a multiethnic population in Hawaii. Methods We performed a retrospective study on statewide inpatient data for delivery hospitalizations in Hawaii between January 1995 and December 2013. Multivariable logistic regression was used to assess the impact of maternal race/ethnicity on the rates of preeclampsia after adjusting for age, multiple gestation, multiparity, chronic hypertension, pregestational diabetes, obesity and smoking. Results A total of 271,569 hospital discharges for delivery were studied. The rates of preeclampsia ranged from 2.0 % for Chinese to 4.6 % for Filipinos. Preeclampsia rates were higher among Native Hawaiians who are age <35 and non-obese (OR 1.54; 95 % CI 1.43–1.66), age ≥35 and non-obese (OR 2.31; 95 % CI 2.00–2.68), age ≥35 and obese (OR 1.80; 95 % CI 1.24–2.60); other Pacific Islanders who are age <35 and non-obese (OR 1.40; 95 % CI 1.27–1.54), age ≥35 and non-obese (OR 2.18; 95 % CI 1.79–2.64), age ≥35 and obese (OR 1.68; 95 % CI 1.14–2.49); and Filipinos who are age <35 and non-obese (OR 1.55; 95 % CI 1.43–1.67), age ≥35 and non-obese (OR 2.26; 95 % CI 1.97–2.60), age ≥35 and obese (OR 1.64; 95 % CI 1.04–2.59) compared to whites. Pregestational diabetes (OR 3.41; 95 % CI 3.02–3.85), chronic hypertension (OR 5.98; 95 % CI 4.98–7.18), and smoking (OR 1.19; 95 % CI 1.07–1.33) were also independently associated with preeclampsia. Conclusions for Practice In Hawaii, Native Hawaiians, other Pacific Islanders and Filipinos have a higher risk of preeclampsia compared to whites. For these high-risk ethnic groups, more frequent monitoring for preeclampsia may be needed.



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Alterations in diets of patients with non-celiac gluten sensitivity compared to healthy individuals

Clinical Gastroenterology and Hepatology

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Diffusion-weighted MRI for hepatocellular carcinoma screening in chronic liver disease: Direct comparison with ultrasound screening

Journal of Medical Imaging and Radiation Oncology

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Prevalence of hepatitis B and clinical outcomes in inflammatory bowel disease patients in a viral-endemic region

BMC Gastroenterology

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Wound complications and perineal pain after extralevator versus standard abdominoperineal excision: a nationwide study

Diseases of the Colon and Rectum

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Institutional variation in short- and long-term outcomes after surgery for gastric or esophagogastric junction adenocarcinoma: Correlative study of two randomized phase III trials (JCOG9501 and JCOG9502)

Gastric Cancer

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Assessment of the incidence of chronic pain and discomfort after primary inguinal hernia repair

Journal of Surgical Research

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Antibiotic use in acute pancreatitis: An audit of current practice in a tertiary centre

Pancreatology

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Severe obesity in adults cost state medicaid programs nearly $8 billion in 2013

Health Affairs

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Aspirin use in secondary cardiovascular protection and the development of aspirin-associated erosions and ulcers

Journal of Cardiovascular Pharmacology

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Development and validation of visceral fat quantification as a surrogate marker for differentiation of Crohn's disease and Intestinal tuberculosis

Journal of Gastroenterology and Hepatology

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Relationship of clinical symptoms with biomarkers of inflammation in pediatric inflammatory bowel disease

European Journal of Pediatrics

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Factors influencing participation in colorectal cancer screening--a qualitative study in an ethnic and socio-economically diverse inner city population

Health Expectations

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Association between the age and the development of colorectal cancer in patients with familial adenomatous polyposis: A multi-institutional study

Surgery Today

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Post-transplant monitoring of NK cell counts as a simple approach to predict the occurrence of opportunistic infection in liver transplant recipients

Transplant Infectious Disease

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The transinguinal preperitoneal technique (TIPP) in inguinal hernia repair does not cause less chronic pain in relation to the ProGrip technique: a prospective double-blind randomized clinical trial comparing the TIPP technique, using the PolySoft mesh, with the ProGrip self-fixing semi-resorbable mesh

Hernia

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HCVIVdb: The hepatitis-C IRES variation database

BMC Microbiology

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Prevalence, factors and consequences of dating violence in a tertiary institution in Southern Nigeria

2016-08-30T00-35-53Z
Source: International Journal of Community Medicine and Public Health
Christian N. Iwemjiwe, Hilda O. Okojie.
Background: Dating violence occurs in a relationship and may have immediate as well as long term implications for victims, perpetrators, family and community. This study aimed to identify the prevalence of the different components or various types of dating violence, factors associated with dating violence and effects of dating violence on undergraduates in University of Benin. Methods: The study was carried out in the campuses of University of Benin, Benin City. A cross-sectional descriptive study method was used and the study lasted for three months. Data were generated through the use of self-administered questionnaires distributed to respondents in all faculties and schools. A total of 400 respondents were selected using stratified sampling technique. Data were analysed with statistical package for social sciences software SPSS version 16. Results: The findings showed a prevalence of 76.4% for dating violence. The highest number of reported cases was in the age range 19-24 years. There was a significant association between dating violence and age, sex, and co-habiting of partners of the respondents. Dating violence was not dependent on residence of the respondent. Physical violence was the highest suffered by the respondents 54.4%, while sexual violence was the least 23.3%. Conclusions: The study has established that dating violence is a problem in the University which needs to be prevented through school-based education and awareness programmes.


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A study on association between breastfeeding and its protective role against diarrhoea in under five children in a rural block of West Bengal, India

2016-08-30T00-35-53Z
Source: International Journal of Community Medicine and Public Health
Atanu Biswas, Asok Kumar Mandal.
Background: Diarrhoea is not only one of the most common childhood illnesses, but also one of the leading causes of under nutrition and even childhood mortality globally. Breast milk is known to have protective role against childhood infections, thus preventing diarrhoea and its consequences. Methods: This cross sectional study aims to assess the pattern of breastfeeding and also episodes of diarrhoea in previous three months before the day of interview, and also the association between breastfeeding and its protective role in diarrhoea in children of less than 5 years of age. Data was collected from 81children (their mothers being respondents) and was statistically analysed using IBM SPSS (Version 20.0). Results: Only 55.6% children were exclusively breastfed up to six months or till date in children


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Screening for cervical cancer during pregnancy

2016-08-30T00-35-53Z
Source: International Journal of Community Medicine and Public Health
Banumathy Manikkam.
Background: Carcinoma cervix is the second most common gynaecological cancer causing deaths among women. PAP smear being most sensitive and specific screening test reducing mortality and morbidity, can be used to identify early changes in cervix during pregnancy. The aim of the study was to offer cervical cancer screening for pregnant women and motivate them into the mainstream of screening subsequently and evaluate their acceptance. Also to identify reproductive tract infections, associated pregnancy changes and their effect on pregnancy outcome. This prospective study enrolled 200 normal pregnant patients admitted at Sri Rama Krishna Hospital from September 2012 to January 2014. Methods: All the patients selected for this study underwent history taking and examination .Pap smear was taken with patient in dorsal position. Among 200 cases, 196 (98%) were adequate smears and only 4 (2%) were inadequate. Adequate smears which were grouped as per Bethesda system, majority (97.5%) fell in Group I and were found to be normal or inflammatory smear, while only one showed ASCUS. Of the cases in Group I, 114 cases (57%) showed inflammation while 81 cases (40.5%) were normal. Statistical analysis used was SPSS 11.5. Results: Majority of the patients involved in study were in the age group of 20-35years with only 3.5% below 19yrs and 2% above 35years with mean age of 26.9years. Most of the patients were married at 20-30yrs of age while only 4.5% were married after 30 with mean age of marriage 23.4yrs. Importantly 15% had an early marriage between 15-19yrs. Most of patients who consented for study belonged to third trimester (91.5%) followed second trimester (17%) with average of 32.7wks. About 80% had knowledge regarding screening for cervical cancer. Statistical analysis used was SPSS 11.5. Conclusions: PAP smear being a cost effective, easy to perform test, can be carried out even in pregnant woman. It does not interfere with the natural course of pregnancy and hence safety is ensured. Pregnancy is a potential opportunity to counsel and educate them regarding the significance of screening.


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Evaluation of availability and utilization of obstetric care services and entitlements under Janani Suraksha Yojana in Mysore, India

2016-08-30T00-35-53Z
Source: International Journal of Community Medicine and Public Health
Hugara Siddalingappaa, Narayana Murthy M. R., Maya Mascarenhas, Varsha Hoogar, Pradeep T. S., Sulekha T., Prem K. Mony.
Background: To reduce maternal and infant deaths due to preventable causes by promoting institutional delivery, conditional cash transfer scheme, Janani Suraksha Yojana (JSY) program was launched in India. The aim of the study was to assess the availability and utilization of obstetric care services and monetary benefits under the scheme by pregnant women, completeness of services and timeliness of sanction of cash incentives and its effect on institutional deliveries in the study area. Design of the study was community based cross- sectional survey. Methods: Mixed method research done in four Primary Health Centre (PHC)s selected by stratified random sampling method using survey and Focussed Group Discussion methods. Statistical analysis was univariate and bivariate analysis using SPSS. Results: Among 510 mothers interviewed, registration of pregnancies was 100% and 99.6% mothers had more than three ANC check ups. Institutional delivery rate was 98.8%. Among the 484 scheme eligible, 385 (79.5%) had got JSY money. Reason for not getting the money were, lack of documents, bank accounts, not linking UID (Aadhar) number to the bank account and delay was due to shortage of funds in the PHC. Conclusions: CPSMS was the major method of disbursement (65%). Most of the mothers got money after three to four months delay. 63% of the study participants in the study area had got full range of obstetric care services recommended through JSY.


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Prevalence of hypertension and its associated risk factors in a sub-urban area of central Nepal

2016-08-30T00-35-53Z
Source: International Journal of Community Medicine and Public Health
Shovana Shrestha, Rashmi Devkota.
Background: Burgeoning burden of non-communicable diseases (especially hypertension) along with communicable diseases has made the situation more worrying in an economically constraint countries like Nepal. Studies are therefore necessary to assess the actual burden of disease; however nominal studies have focused this situation especially in semi urban areas of Nepal. This study was therefore conducted with the main aim of assessing the prevalence of hypertension in suburban area of central Nepal and to find the associated risk factors. Methods: A cross sectional study was conducted in a sub urban area of Changunarayan municipality of Nepal utilizing consecutive convenience sampling method. A total of 240 consenting participants aged ≥18 were enrolled in the study. Data was collected using questionnaire and measurements of blood pressure, waist/hip circumference, height and weight were taken. Chi square test was used to assess the strength of relationship between the categorical variables with p value taken significant at ≤0.05. Only values with significant association were used to obtain the Odds Ratios (OR) via binary logistic regression. Results: The prevalence of hypertension and pre-hypertension was found to be 20.4% and 35.4% respectively. Further, study illustrates the significant association (p≤0.05) of age, gender, family type, presence of co-morbidities, smoking, alcohol intake habits, habit of adding salt, BMI and waist/hip ratio with hypertension. Conclusions: Results of high prevalence of hypertension and its association with several factors indicates the necessity for timely detection, treatment and control of hypertension using various strategies.


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To assess the effect of antiretroviral therapy on HIV/AIDS patients at art plus center Bhopal: a retro respective study

2016-08-30T00-35-53Z
Source: International Journal of Community Medicine and Public Health
Hemant Verma, Bhavishya Rathore, Jeetandra Sharma, Manju Toppo.
Background: To assess the immunological and clinical progress of human immunodeficiency virus/acquired immune deficiency syndrome patients on antiretroviral therapy at antiretroviral therapy (ART) center Bhopal, Madhya Pradesh, India. Methods: Retrospective medical records review was conducted to determine the immunological and clinical progress of HIV/AIDS patients. The records of patients on their clinical stage, cluster of differentiation 4 (CD4) Count, and working status were reviewed. Results: A total number of 5295 patients were included in the study. The mean age was 33.39 Years and standard deviation 11.84 years; it ranged from 0.5 to 82years. Number of males was 3441 (64.98%), females formed 1829 (34.54%), while transgender 25 (0.47%). Out of 5295 patients 3314 (%) are eligible and initiated ART. And out of 3314 patients, 1903 patients continue to be present at their follow up visit for regular clinical and pathological checkup. The mean weight of the patients increased from 49.59kg to 52.41 after 12 months of therapy. Mean CD4 cell counts as 231cells/mm3 during the first follow up increase to 443 cells/mm3 at 2nd visit. Before ART 674 Patients were working and 373 were bedridden and after 1 year of ART 1028 were became belongs to working group and only 197 were remains bedridden. Percentage of patients in stage III became 38.94% (from 48.84%) followed by Stage II 38.36% (from 23.08%). Conclusions: Study concluded that the patients taken ART were shown to experience improved health status in general.


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Knowledge and health seeking behaviour of tuberculosis patients in Kerala, India

2016-08-30T00-35-53Z
Source: International Journal of Community Medicine and Public Health
Selvam Paramasivam, Bina Thomas, Jayakrishnan Thayyil, Asma Rahim, Jayakrishnan Thavody, Lilabi M. P., Jayadev V. K..
Background: Patients confront several problems in timely and effective utilization of TB health facilities which have often delayed diagnosis of TB. It is hence the need of the hour to look beyond the case detection rates towards other factors that can promote early diagnosis. Methods: A community-based cross-sectional study was conducted among newly diagnosed smear positive pulmonary tuberculosis patients aged ≥15 years on the Intensive Phase of treatment. A pretested semi-structured questionnaire was used to study knowledge, stigma, health seeking behaviour and other factors. Results: The predominant symptom for seeking care was cough (93.0%). 45.7% of patients sought the services of a health care provider within 2 weeks. Modern medicine was the preferred system for 94.7% of the patients. The majority (58.6%) of the patients consulted a private health facility. Illiterates and Below Poverty Line patients preferred government facilities. The average number of consultations before diagnosis was 3.11±1.9. 34.1% had adequate knowledge about tuberculosis and women had a significantly higher knowledge score. low per capita income, smoking and alcohol use, cough alone, cough with other symptoms, history of TB in Family, distance more than ≥ 5 km to health facility showed significant association with delayed health-seeking action (>14 days). Conclusions: Private practitioners and private hospitals were the predominant health providers preferred by the study subjects for the first consultation. Delayed health seeking action was probably due to the presence of a cough alone and coughs with other symptoms, history of tuberculosis among the family members and increased distance to TB health facility.


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Pattern of internet addiction among adolescent school students of a North Indian city

2016-08-30T00-35-53Z
Source: International Journal of Community Medicine and Public Health
Manohar Bhatia, Manbahadur Rajpoot, Vikash Dwivedi.
Background: In recent years, the internet and mobile technology have become increasingly important and essential to the educational and social lives of adolescents. But in many cases this use is becoming obsessive and at the expense of other aspects of their life. Almost 35% of internet users in India are adolescents and so this study was conducted to assess the prevalence of internet overuse among school going adolescent students. Methods: It was a cross-sectional survey conducted among 300 students in three private schools in the city of Gwalior, Madhya Pradesh. Youngs twenty question internet addiction test questionnaire was used to measure internet addiction. Results: 61.34% students started using internet after 12yrs of age while 38.66% students said that they started using internet before 12 year of age. 26.33% students spent 4 hour or more online per day. 28.66% students admitted that their school work was often delayed or incomplete due to spending more time on internet. Out of 300 students, 24.00% (72) were in the score range of 50-79 i.e. moderate addiction and 06.33% (19) were in the score range of 80-100 i.e. severe addiction. Conclusions: Parents and schools need to counsel their adolescent children regarding appropriate use of internet and balancing of time between internet surfing, studies and outdoor physical activities.


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Intestinal protozoa infections, associated risk factors and clinical features among children in a low-income tea plantation community in Sri Lanka

2016-08-30T00-35-53Z
Source: International Journal of Community Medicine and Public Health
Lahiru S. Galgamuwa, Devika Iddawela, Samath D. Dharmaratne.
Background: Information on associated factors and current health impact on intestinal protozoa infections in tea plantation community in Sri Lanka is insufficient. The purpose of this study was to describe risk factors and clinical manifestations of intestinal protozoa infections among children in a tea plantation community in Sri Lanka. Methods: An interviewer administered structured questionnaire was used to collect data on socio-demographic characteristics and clinical features of children. Protozoa infections were diagnosed by direct wet smears, formal-ether concentration technique and Ziehl-Neelsen staining technique. Results: 489 children aged 112 years participated and the overall prevalence of intestinal protozoan infection was 18.4%. Entamoeba coli was the most common intestinal protozoa (16.9%) followed by Blastocystis hominis (1.4%), Iodamoeba buschilli (0.2%), Entamoeba histolytica (0.2%) and Giardia intestinalis (0.2%). Multivariate analysis identified eating unwashed fruits (p=0.003), nail biting (p=0.024) and sucking fingers (p=0.018) as statistically significant factors with intestinal protozoa infections. Conclusions: Health education programs promoting awareness about health and hygiene and improving sanitation facilities are recommended to reduce the morbidity associated with intestinal protozoa infections among this population.


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Socioeconomic and regional disparities in safe delivery in India (1990-2006)

2016-08-30T00-35-53Z
Source: International Journal of Community Medicine and Public Health
Jeetendra Yadav, Shyama Gupta, Kh Jiten Kumar Singh.
Background: Giving birth to a child is not only a strain for the body, but it also puts the womans health at risk. Globally, nearly 300,000 thousand women die each year as a result of pregnancy related complications. India, with a population of more than 1.21 billion, has the highest maternal mortality in the world (estimated to be 56000 in 2010). Addressing the maternity care needs of women may have considerable ramifications for achieving the Millennium Development Goal (MDG)-5. The proportion of births attended by skilled health personnel (safe delivery) is one of the main indicators used to monitor progress in reaching MDG 5. The main objective of this study was to the traces the changes in utilization patterns and determinants of safe delivery care services by women in India, during last one and half decade, 1990-2006. Methods: Data from three rounds of the Demographic and Health Survey (DHS), known as the National Family Health Survey (NFHS) in India were analyzed. Bivariate and multivariate-pooled logistic regression model were applied to assessing the trends and determinants of safe delivery care services utilization, over one and half decade, 1990-2006 and also fit models stratified by survey periods and with interactions among key socioeconomic predictors to show the extent of disparity in the utilization of safe delivery care services among women belonging to different socioeconomic strata. Results: The results from analysis indicate that the coverage of safe delivery has increased from 34 percent to 50 percent during the last one and half decade. Overall, it can be said that, there was an improvement in the level of safe deliveries over the period of time. This improvement was somewhere very marginal, but somewhere very pronounced too. The results shows those womens education, husbands education, religion, caste, mass media exposure, birth order and interval, wealth quintile and region of residence were found to be statistically significant determinants in the utilization of safe delivery care services. Women from the Southern region utilizing the highest safe delivery care services compared to other regions. Conclusions: The region specific inequalities, which were greater than the socioeconomic inequalities, may be reduced by expanding outreach health programs to bring services closer to the disadvantaged. Promoting the use of family planning, female education, targeting vulnerable groups such as poor, illiterate, high parity women, involving media and grass root level workers and collaboration between community leaders and health care system could be some important policy level interventions to address the unmet need of safe delivery care services among women. Maternity programmes should be designed keeping in mind the socioeconomic and geographically context, especially women who belongs to EAG states, India.


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An epidemiological study of protein energy malnutrition among children below six years’ age in an urban slum of Gurgaon, Haryana, India

2016-08-30T00-35-53Z
Source: International Journal of Community Medicine and Public Health
Tarun Kumar, Balbir Singh Deswal.
Background: Poorly nourished child grows less rapidly during first 6 years of age. In India, around 43% of fewer than five children were underweight. Child protein energy malnutrition reflects a number of intermediately processes such as household access to food, access to health service and caring practices. The present study was undertaken to assess prevalence of PEM as well as the nutritional status of children below six years age group and to explore most probable risk factors influencing PEM. Methods: The study was a community based cross-sectional study carried out in 500 randomly selected households in a slum area of Gurgaon among the children below 6 years of age using pretested Performa which contained details regarding socio-demographic, nutritional conditions and utilization of health care services. Nutritional status was assessed by Physical examination, anthropometric measurement, haemoglobin and parasitological (stool) tests. Nutritional grading was done according to by physical and anthropometric examination of child using Indian Academy of Pediatrics (IAP) classification and supplemented by WHO growth chart. Data was entered in the MS Excel sheet and analyzed using Epi info Ver 7. Results: During survey acute illness detected among 0.25% children and chronic illness prevalence was 25%. Prevalence of PEM was found to be 43.86% (37.73% among males, 50.0 % among females). Clinical signs of nutritional deficiency were detected among 31.48 % of children. Common types of nutrition deficiency were anemia, PEM, and vitamin A and B complex deficiencies. Main reasons of PEM were attributed to female sex, poor literacy of parents, low socioeconomic status, higher No. siblings and large family, recurrent diarrhea and other infections, prolonged breast feeding with delayed introduction of supplements particularly semisolid and poor quality of supplements. Intestinal parasite detected among 38.43% of children, commonest parasite being giardia, ascariasis and thread worms; existing health services utilized in 30.72% of total illness. This was identified not due to lack of knowledge but other domestic problems. Conclusions: Prevalence of PEM was attributed to poor living conditions, poor literacy status of parents, higher No. of siblings, poor utilization of health services, poor nutritional services of children and faulty breast feeding and weaning practices in the family. Public health specialists should plan interventions focusing on these issues.


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Study of diagnostic methods used in admitted malaria cases at tertiary care centre

2016-08-30T00-35-53Z
Source: International Journal of Community Medicine and Public Health
Nitin H. Kamble, Alka C. Kaware, Durga M. Satapathy.
Background: Malaria is one of the most important vector borne diseases causing significant morbidity and mortality. With change in epidemiology, genetic perturbations and vector characteristic along with P. Falciparum, P. Vivax cases also presents with complicated malaria leading to increased mortality. The objective was to study diagnostic methods used in admitted malaria cases at tertiary care centre. Methods: Retrospective record based descriptive study. The data was collected from the bed tickets in the record room of SCBMC, Cuttack, over 3 calendar years i.e. 2010, 2011 and 2012, using predesigned and pretested formats. The data thus collected were analysed using statistical software. Results: Out of total 8282 cases, in 5565 (67.2%) cases malaria test was done. In 294 (3.5%) cases test was done and in 2423 (29%) data was not available. Out of 5565 cases, in 3775 cases the test result was negative (67.84%). From the rest in 980 cases it was Plasmodium falciparum positive (17.61 %), in 163 cases it was Plasmodium vivax positive (2.93%), in 598 cases it was mixed positive (10.75 %) and in 49 tickets the details of the plasmodium species was not mentioned even though it was mentioned as MP positive. ICT was the commonest used modality of testing being used in 5375 out of 5565 cases (96.5%). Conclusions: Majority were positive for falciparum, followed by mixed for both Pf and Pv and remaining were positive only for P vivax. Antigen tests (such as ICT/RDK) were the main modalities of lab confirmation of parasite rather than the gold standard of slide test.


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Study of biofilm production and antimicrobial sensitivity pattern of uropathogens in a tertiary care hospital in North India

2016-08-30T00-35-53Z
Source: International Journal of Community Medicine and Public Health
Pragyan Swagatika Panda, Uma Chaudhary, Surya K. Dube.
Background: Urinary tract infection (UTI) is one of the most common infectious diseases encountered in clinical practice. Emerging resistance of the uropathogens to the antimicrobial agents due to biofilm formation is a matter of concern while treating symptomatic UTI. But studies addressing the issue of biofilm production by uropathogens in Indian scenario are scarce. Aim of the study was to study biofilm formation and antimicrobial sensitivity pattern of uropathogens. Methods: Prospective observational study conducted in a tertiary care hospital. Total 300 isolates from urinary samples were analysed for biofilm formation by tissue culture plate method. We compared the antimicrobial sensitivity pattern of the biofilm producing and non-producing uropathogens. For statistical analysis Chi-square test was applied when two or more set of variables were compared. A p value of


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Prevalence of dyslexia among school children in Mysore

2016-08-30T00-17-13Z
Source: International Journal of Medical Science and Public Health
Shivani Rao, Ajay Raj S., Visalam Ramanathan, Arun Sharma, Murali Dhar, Pandurang Vithal Thatkar, Ranabir Pal.
Background: Dyslexia is defined as difficulty in learning to read and spell despite adequate education, intelligence, socio cultural opportunities and without any obvious sensory deficits. Objective: 1) To estimate the prevalence of dyslexia among school children. 2) To study the factors associated with dyslexia. Materials and Methods: A cross-sectional study conducted in 4 randomly selected government schools of Mysore for a period of two months from August 2013 to September 2013. Data was collected by using a pretested dyslexia screening questionnaire. Result: Out of 400 students overall prevalence of dyslexia was found to be 13.67%. When compared with gender, prevalence of dyslexia was 19.00 % among males and 8.50% among females. About 66.70% dyslexics gave a family history of dyslexia. History of difficulty with spellings was seen among 54.80% of dyslexics. About 61.70% experienced difficulty in copying from the blackboard, 56.30% were confused following instructions while playing games. It was noticed that about 64.30% dyslexics were left handed. It was found that 64.30% dyslexics were unable to count backwards from 100 down to 0 and about 77.80% dyslexics were observed reversing numbers or digits. Eighty percent of dyslexics had difficulty in following directions like left and right. On observing their handwriting 59.60% dyslexics had illegible handwriting. Conclusion: This study suggests that the prevalence of dyslexia is on a higher side which suggests that more prevalence studies is required to develop remedial education and policy interventions in the educational system to improve the school performance of such children.


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The study of role of magnetic resonance cholangio-pancreatography (MRCP) in pancreato-biliary disorders

2016-08-30T00-17-13Z
Source: International Journal of Medical Science and Public Health
Nehal Diwanji, Rajeev B Dibbad, Mona Sastri, Ekta Desai.
Background: Evaluation of suspected biliary obstruction has traditionally involved a variety of imaging modalities including ultrasonography (US), computed tomography (CT), and invasive cholangiography. These techniques have limitations because of poor visualization of intra-ductal stones on US and CT and the need for invasive procedures like endoscopic retrograde cholangio-pancreatography (ERCP) and percutaneous transhepatic cholangiography (PTC). Magnetic resonance cholangio-pancreatography (MRCP) is a non-invasive imaging modality that provides good visualization of the hepato-biliary system. Objective: To describe the MRCP appearance of pancreatico-biliary diseases and differentiating benign from malignant strictures, and also to determine sensitivity, specificity, and accuracy of MRCP in the detection of pancreatico-biliary diseases. Materials and Methods: A prospective study carried out over a period of 2 years. If on ultrasonography patient having pancreticobiliary disease then s/he would be selected for the study. Once the patient agrees to participate in the study, information is obtained as per the performa. MRCP was done in all participants. Result: The peak incidence of pancreatico-biliary diseases is seen in the age group of 6170 years with 9 (22.5%) participants. Common presenting complaint were right upper quadrant pain seen in 37 (92.5%) patients followed by yellowish discoloration of skin and sclera, present in 29 (32.5%) of patients. The cases of cholangiocarcinoma predominated and was seen in 08 (20 %) patients followed by choledochal cyst in 06 (15 %) and cholelithiasis-choledocholithiasis in 6 (15%). Benign diseases were seen in 21 (52.5%) participants while malignant diseases in 19 (47.5%). Sensitivity and specificity of MR pancreatico-cholengiography scan for pancreatico-biliary diseases was nearly 95%. Also accuracy of diagnosis was also 95%. Conclusion: MRCP is providing useful criteria in differentiating benign from malignant strictures. MRI in combination with MRCP has the advantage of multiplanar capability, high tissue contrast, combining projectional, and cross sectional images in the evaluation of the biliary system. After the initial USG examination in these patients, the next investigation should be MRI with MRCP.


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Effect of breastfeeding on atopic dermatitis among Saudi infants up to 6 months old in Makkah, Saudi Arabia

2016-08-30T00-17-13Z
Source: International Journal of Medical Science and Public Health
Tahani Magliah, Salwa Bardisi, Ahmad Alliali.
Background: Atopic dermatitis (AD) is a common health problem. The increase in the incidence of atopy has been referred to as alarming by some researchers. AD is an itchy skin condition that appears in infants, often involving the flexural areas inside the elbows and knees. It presents with redness, dryness, scaling, and crusts over much of the body. Objective: To investigate the effect of breastfeeding on AD among infants up to 6 months. Materials and Methods: Two hundred infants were involved in this cross-sectional study. Their ages ranged from birth up to 6 months. The positive cases of AD were confirmed and diagnosed by pediatricians as the mothers approved. They were chosen randomly by filling the questionnaires through their mothers. Then, the questionnaires were collected, and were separated into two groups: exclusively breastfeeding children (n=100) and formula milk (bottled milk) exclusively feeding infants (n=100). They were compared for any attacks of AD, number of attacks, severity, and areas involved in AD. Result: Of the 100 exclusively breastfed infants, 43 (43%) developed AD, while of 100 exclusively formula milk-fed infants, 63 (63%) developed AD. The difference was statistically significant (P=0.0003). Three (6.9%) exclusively breastfed children compared with 19 (30.1%) exclusively formula milk-fed infants needed hospitalization to relieve their symptoms (P = 0.00026). Conclusion: Breastfeeding is a protective factor to decrease the number of attacks of AD and lessen the severity of each attack. Therefore, breastfeeding since birth is recommended as a protective factor or/and immune factor to decrease the number of attacks and the severity of each attack of AD.


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Factors affecting intra-oral pH – a review

Summary

One of the greatest challenges to modern dentistry is the progressive destruction of tooth material due to chemical erosion. Dental erosion is the loss of dental hard tissue, without the action of bacteria, in which demineralisation of enamel and dentine results due to a decrease in intra-oral pH. The aim of this review was to appraise the scientific literature on the factors that can affect intra-oral pH. The review will examine (i) the protective role of human saliva, in terms of its mineral composition, flow rates and buffering systems and (ii) sources of in-mouth acids such as extrinsic acids, which are derived from the diet and environment, as well as intrinsic acids, which are related to disorders of the gastro-oesophageal tract. This review may assist clinicians to identify the risk factors for tooth wear and to recommend adequate preventive measures to patients.



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Validity of three screening questions (3Q/TMD) in relation to the DC/TMD

Summary

Temporomandibular disorders (TMD) are common but seem to be largely undetected within general dental care. To improve dentists' awareness of these symptoms, three screening questions (3Q/TMD) have been introduced. Our aim was to validate 3Q/TMD in relation to the diagnostic criteria for TMD (DC/TMD), while taking into account the severity level of the symptoms. The study population consisted of 7831 individuals 20–69 years old, who had their routine dental check-up at the Public Dental Health Service in Västerbotten, Sweden. All patients answered a health declaration, including the 3Q/TMD regarding frequent temporomandibular pain, pain on movement and catching/locking of the jaw. All 3Q-positives (at least one affirmative) were invited for examination in randomised order. For each 3Q-positive, a matched 3Q-negative was invited. In total, 152 3Q-positives and 148 3Q-negatives participated. At examination, participants answered 3Q/TMD a second time, before they were examined and diagnosed according to DC/TMD. To determine symptom's severity, the Graded Chronic Pain Scale and Jaw Functional Limitation Scale-20 (JFLS-20) were used. In total, 74% of 3Q-positives and 16% of 3Q-negatives met the criteria for DC/TMD pain or dysfunction (disc displacements with reduction and degenerative joint disorder were excluded). Fifty-five per cent of 3Q-positives had a TMD diagnosis and CPI score ≥3 or a JFLS-20 score ≥5, compared to 4% of 3Q-negatives. The results show that the 3Q/TMD is an applicable, cost-effective and valid tool for screening a general adult population to recognise patients in need of further TMD examination and management.



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